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Can you Charge a Medicare Patient for a No Show Fee? 2022 Update

by | Sep 30, 2022 | Medicare

Can You Charge a No Show Fee to a Medicare Beneficiary?

Yes, you are allowed to charge a no show fee to a Medicare beneficiary as long as you have an established no show fee policy for all patients at your practice.

“According to Chapter 1, section 30.3.13 of the Medicare Claims Processing Manual – CMS’s policy is to allow physicians and suppliers to charge Medicare beneficiaries for missed appointments, provided that they do not discriminate against Medicare beneficiaries but also charge non-Medicare patients for missed appointments.”

Reference: Chapter 1, section 30.3.13 of the Medicare Claims Processing Manual

No Show Fee Medicare

Missed Business Opportunity

This is an interesting choice of words. Since the fee is not for an actual covered service, the provider is not required to issue an advanced beneficiary notice and is not subject to the Medicare physician fee schedule.

What Qualifies as a Missed Appointment?

CMS Chapter 1, section 30.3.13 does not provide specific guidance in regards to how a missed appointment is defined.

No Shows

Your practice must have a policy manual and within that policy manual, you must define, in writing, what a “no show” is.

For example, a “no show” may be defined as a non-arrival within 5-minutes of the scheduled appointment time.

Why 5-minutes? Because some practices could have an established policy that states that once a patient is more than 5-minutes late for an appointment that appointment is considered a no-show and the scheduled therapist will perform other activities for the remainder of the appointment time.

Cancellations

Your cancellation policy must also describe the difference between a cancellation that may be rescheduled and a cancellation that is considered a missed appointment.

Many providers have chosen a 24-hour threshold to say that any cancellation occurring with less than 24-hours of notice is considered a missed appointment and subject to the missed appointment policy.

Weekend Cancellations?

How do you plan to handle weekend cancellations? There will be occasions in which your patient has an appointment scheduled for Monday morning and your 24-hour cancellation policy would require that patient to cancel on or before Sunday morning.

Voicemail Cancellations

Will your policy allow for voicemail cancellations? If your voicemail system timestamps the day and time a message is left you may want to include this in your cancellation policy.

Email Cancellations

Does your practice accept cancellations by email? Similar to voicemail, these may be acceptable to you if the email is timestamped with more than 24-hour notice, but this must be included in your policy manual.

Text Message Cancellations

My favorite method as a practice owner is text message cancellation. I may not want to check voicemail or email over the weekend, but if I receive a text message cancellation the first appointment on an otherwise busy morning I will usually appreciate the notification and use that time accordingly.

Your policy manual should indicate whether you accept text message cancellations and what telephone number that message should use.

No Show Fee for Medicare Patients
Physical Therapy Claim Denials & Reason Codes

Physical Therapy Claim Denials & Reason Codes

by | Mar 10, 2022 |

Table of Contents: Reason Code 59 Reason Code 119 Physical Therapy Claim Denials Reason Code 59 While MPPR is not part of physical therapy claim denials, it is often mistakenly thought to be a claim denial by therapists and new billers. The definition of MPPR is...